Provider Demographics
NPI:1134609308
Name:SW ARKANSAS FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:SW ARKANSAS FOOT AND ANKLE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOTTA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-762-8485
Mailing Address - Street 1:110 PONDEROSA LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-762-8485
Mailing Address - Fax:501-762-8085
Practice Address - Street 1:110 PONDEROSA LN
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-762-8485
Practice Address - Fax:501-762-8085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SW ARKANSAS FOOT AND ANKLE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty